Wednesday, May 21, 2008

The Routine

It is no secret that the majority of what we do in EMS is deal with the mundane. Routine chest pain, the ubiquitous "cold and flu" symptoms, benign shortness of breath calls and a mixed bag of minor trauma: these things fill up our days often from start to finish. Though these calls are far from the flashy stories of life and death, the reality is we ambulance drivers are much more experienced at dealing with the quasi sick than with we are with the deathly ill.

Those complicated calls - the ones where we are forced to make tough decisions or recognize an elusive pathology - those are diamonds in the rough. They happen so infrequently that news of them spread far and wide, across our service and beyond as tales of so-and-so's call permeates distance and time. If someone gets a good call, even in this city, you can bet that most will have heard about it by day's end. It seems sometimes that truly challenging calls are so rare, that when they do occur we find ourselves so surprised and unpracticed that we might be glad to get through it all without making an idiotic mistake. My last entry on this blog might serve as case in point.

And yet those calls are the reason why so many of us decided to do this job. I hope I have convinced my readers by this time that I have a genuine interest in medicine and that I do my best to learn from each and every patient, but I must admit that I too do what I can to seek out those elusive diamonds in the rough. I want to be challenged. I want the excitement and pressure of the unfamiliar. I want to be able to say that I've been there before. I want to respond to the side of a patient for whom a special skill or talent might mean the difference between better and worse. Who doesn't, right?

...But the mundane. Oh, the mundane. It is almost suffocating in it's volume. Paralyzing in it's persistence. My days are absolutely filled with it, and I find myself sometimes in the backs of ambulances, plugging away at the routine ALS as if my job could be performed by a machine. We get dispatched to calls like a short order cook during lunch rush. Chronic back pain. Hand swelling. Car crash and everyone is out walking around. We trudge through it for twelve hour shifts, heads high only for the hope that one of these might turn out to surprise, to challenge or intrigue. There are a lot of disappointments.

I would like to know how those who have been doing this job for a long time are able to withstand the mundane. Do they no longer live for the exciting calls? Are they content to relax in the routine, or have they a way to find interest in the subtleties that I may perhaps miss in my eagerness for something new?

Am I missing something?

Monday, May 5, 2008

Mistakes and Bad Paramedics

A few shifts ago, I made a mistake.

Not a regular every-day kind of mistake, but a critical one. It was something we've been taught from the beginning. Basic, and yet in the heat of the moment of a call wrecked with the unfamiliar and quick decisions, I forgot. And really, there was nothing more than that. I simply forgot.

What I should have done now appears impossibly clear. The benefit of time and conscious reflection has forced those decisions outward for inspection, starkly naked and illuminated in the harsh light of all that only now seems heartbreakingly obvious. I'd slap my forehead if the expression wouldn't so drastically underestimate the seriousness of my own omission. This time it was real, and it counted.

I suppose on a large enough scale, I can afford myself the opportunity to sit back and comment that these kinds of mistakes are unavoidable. We are put in a tough spot, us paramedics. Forced to deal with undifferentiated patients in unfamiliar environments, pressured by time and the sheer inadequacy of our own knowledge, day after day we blindly toss ourselves from scene to scene and patient to patient. As the census numbers climb, a statistician would probably conclude that the opportunity for error climbs as well. The probability most likely doubles with the inexperienced, and increases exponentially as the patients become more and more complex. ...And even though my rationalizing mind would like to point out such explanations, I still find myself looking back on those few minutes with great regret and dismay. I'm new. It was a tough call. But even still, I should have known better.

It brings to mind the oft-tossed around concept of "good paramedics" and "bad paramedics." There are a few at my service who are categorized as at the extremes of each definition, either through rumor or - in some cases - as the result of a few isolated incidents. We hear stories passed around all the time of so-and-so having made a terrible mistake, or another medic making a great call. Each of these stories, most likely taken well out of context, contribute directly to the reputations of people who - I know - work very hard to keep themselves upright against the constantly changing winds of EMS and the patients we find. With all that we are subjected to, I cant imagine that anyone is able to completely keep his head down, maintain an even keel and avoid the extremes. The big mistakes will happen. A stroke of luck sometimes swings our way. And all the while we do our best to maintain. A good paramedic, I imagine, is able to weather the storms at least as well as he rides the highest waves.

And so, as is the usual procedure after an experience such as this, I return to the work of weathering the storm. Not that I caught any real trouble for my mistakes, but there is most certainly a battle that I need to fight with myself. Even experiences like these can prove beneficial if I refuse to let mistakes become the focus, but it doesn't come without a fight. I will most definitely learn from this. I just hope in the meantime that nobody thinks I'm a bad paramedic.